A&E waiting times still a bugbear for patients

SINGAPORE - Hospitals have upgraded and boosted services, but seeing a doctor at the accident and emergency (A&E) department and getting a bed in a ward continues to be a waiting game.

Patients at the A&E wards of six tertiary hospitals waited from an hour to five hours before being admitted to an inpatient ward, according to figures for the second week of this month published on the Ministry of Health (MOH) website.

On Sunday and Monday, patients at Changi General Hospital (CGH) waited as long as seven hours. Bed occupancy rates averaged between 70 per cent and 95 per cent in the same period at these hospitals.

The Health Ministry said the average daily median waiting time for admission to wards across public hospitals has remained largely stable between 2010 and last year.

But waiting times have been a source of frustration in recent years. In a recent national survey, most patients gave health-care institutions here the thumbs up, but were unhappy with long waiting times - which hospitals partly attribute to having to deal with cases that could have been handled by general practitioners (GPs).

Findings from an MOH patient satisfaction survey released earlier this month showed that even though health-care institutions got the nod from eight in 10 patients, waiting times remained a bugbear.

The dissatisfaction was highest at the A&E department, said an MOH spokesman.

About 90 per cent of patients surveyed indicated waiting times in general - from the time spent waiting to see a doctor to getting a bed at the A&E - as an important attribute.

And only about 60 per cent of those surveyed were satisfied with the current level of service tagged to this attribute.

Hospitals said a shortage of beds, more patients and visits from those with non-urgent conditions are causing the problem.

The National University Hospital (NUH) attended to 1,300 more A&E patients a month from January to November this year, compared to 2010.

Singapore General Hospital had 4 per cent more non-critical cases at its A&E department in the past two years.

The growing ageing population and prevalence of chronic diseases have led to a higher number of more urgent cases, said CGH chief executive Lee Chien Earn.

The number of moderate to severe A&E cases went up by a quarter in the first half of this year, compared to last year.

But Dr Lee said more than two-thirds of its less serious cases are visiting the A&E when most GPs are open. Some have conditions such as flu, diarrhoea and sprains that can be managed by a GP.

Between April last year and November this year, an average of 70 per cent of Khoo Teck Puat Hospital's A&E patients were P3 (Priority 3) cases - patients who are unwell but still mobile. P4 cases are non-emergencies.

Hospitals, which have struggled to deal with long waiting times for years, have not let up in finding ways to cope.

Last year, Tan Tock Seng Hospital expanded a facility where certain patients are observed for up to 24 hours instead of being admitted at once. Its admission rates dipped 11 per cent.

At NUH, when the waiting time for a bed is expected to be more than two hours, doctors are called from the wards to initiate treatment while the patient is still at the emergency ward. This was implemented in late 2009.

In 2010, MOH and the Health Promotion Board ran a six-month public education campaign to address the growing number of people using A&E services for minor ailments.

They are working on the next phase of the campaign, which will be rolled out in the first half of next year.

While patients are unhappy with long waits, the National Resuscitation Council chairman, Professor V. Anantharaman, said Singapore actually has a much lower proportion of patients who visit the A&E for non-urgent problems, compared to other places.

"Most are there because they think it is an emergency. Patients here do not intentionally misuse the emergency ward, although there will be the occasional few."

The bigger issue, he added, is the shortage of resources such as beds and doctors.

Respite is on the way, with the 700-bed Ng Teng Fong General Hospital opening in Jurong by end-2014. Sengkang General Hospital will be ready by 2018.

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